I cannot remember the last time that national politics and medicine have been on such a collision course. Americans have becomes accustomed to the groundbreaking but imperfect medical coverage of the Affordable Care Act. And poll after poll shows that people are concerned about losing their coverage if GOP Senators are able to repeal Obamacare without a replacement. Ask the average person if he or she likes the ACA and the overwhelming answer is yes. Ask the question differently, substituting Obamacare, and people complain about federal intrusion. Go figure.

But what to do about this legislation brings another series of problems. Repeal and replace? Even the replacements have caused their own schisms as not being tough enough or stripping coverage from too many. Repeal and let people go uninsured? That’s just plain dumb. Fix the parts that are broken and make healthcare better? That seems like a reasonable starting point but too few smart legislators seem to be putting this option on the table.

The lines in the sand have been drawn with unlikely partners of the AMA, American Hospital Association, AARP, independent physicians, Fortune 500 companies, and even insurers imploring Congress not to gut the coverage offered by the ACA but to fix the broken parts like letting policies work across state lines. The Congressional Budget Office estimates that 22-24 million Americans could lose their insurance if the ACA is tossed aside. That is a high price to pay.

So who will suffer? The answer is most likely America’s most vulnerable….those with marginal incomes, women, children, those with pre-existing conditions like heart disease and cancer. The math won’t work with just kicking the ACA to the curb. And remember, your local emergency room is the most expensive care in the world.

So where do we stand? As things stand today, the ACA remains the law of the land and should be fixed as necessary. I believe in a federal single payer system but am willing to hear about how individual states would propose a stronger system. As for the threats to gut it or repeal it completely, that nuclear option should only be put forth if every single congress person or Senator volunteers to give up his or her healthcare too. Prove to us Congress, that we are all in this together and that you really, really represent the average American.